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HHS Grants Fund Health IT in Communities
Organizations, government agencies, or other community groups that demonstrate the use of health information technology to a wide range of health...
Limitations
There are 3 main limitations to this study. First, because there was no practical way to preidentify participants who participated in implementing e-consults, a modified snowball sampling was used. However, this limited the degree to which the group was representative of the pilot participants. Second, the authors reported findings from a real-world initiative, not an experimental study. As such, not all participants in the first wave of key informant interviews were available for follow-up interview, which may have introduced bias. Third, the VHA is unlike most of the rest of the U.S. health care system in that it is a fully integrated system with salaried PCPs and specialists and an EHR.
Generalizability of the study may be limited, as a modified snowball sampling approach is not entirely random and has potential for community bias, because initial participants influence subsequent sampling. Additionally, though the sample size (n = 37) was sufficient for qualitative, in-depth analysis, it may be too small for confident generalization of findings. However, as health care moves toward an accountable care organization system, the authors’ analysis may provide insights.
Issues include revision of reimbursement policy for e-consults and developing or coordinating informational technology infrastructures to permit e-consults. It is also important to note that this evaluation reports solely on the extent of implementation of e-consults and the effects of e-consult implementation from the perspectives of staff, including specialists and PCPs.
Evaluating the effectiveness of the program in improving access, care coordination, and patient satisfaction was beyond the scope of the study. Further research is needed, because findings on those outcomes are critical for drawing inferences about this study’s implementation results.
Conclusion
The assessment of the e-consult system by providers and staff was based on a perception that e-consults are a valuable tool in providing greater access to quality care. Currently, e-consults have been expanded across VHA in medical and surgical specialties. VHA policymakers have drafted field guidance and a communication plan to support these efforts.
Acknowledgement
This material is based on work supported by the VA Office of Specialty Care Transformation, the office overseeing the e-consult initiative, and the Office of Research and Development Quality Enhancement Research Initiative.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.